Basic Information
| Provider Information | |||||||||
| NPI: | 1710320619 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW LIFECARE HOSPITAL AT TENAYA LLC | ||||||||
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| OtherOrganizationName: | COMPLEX CARE HOSPITAL AT TENAYA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5340 LEGACY DR | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750243178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4692412128 | ||||||||
| FaxNumber: | 4692412177 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 N TENAYA WAY | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891280482 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7025622021 | ||||||||
| FaxNumber: | 7023411356 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2013 | ||||||||
| LastUpdateDate: | 03/05/2014 | ||||||||
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| AuthorizedOfficialLastName: | CRONIN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT - REIMBURSEMENT | ||||||||
| AuthorizedOfficialTelephone: | 4692412128 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282E00000X | 3082HOS-16 | NV | Y | Hospitals | Long Term Care Hospital |
No ID Information.